TY - JOUR
T1 - Safety, feasibility, and effect of remote ischemic conditioning in patients undergoing lung transplantation
AU - Lin, Enjarn
AU - Snell, Gregory I
AU - Levvey, Bronwyn
AU - Mifsud, Nicole Andrea
AU - Paul, Moumita
AU - Buckland, Mark
AU - Gooi, Julian
AU - Marasco, Silvana
AU - Sharland, Alexandra F
AU - Myles, Paul S
PY - 2014
Y1 - 2014
N2 - BACKGROUND: Primary graft dysfunction (PGD) remains a significant problem after lung transplantation. Data from animal and clinical studies suggest that remote ischemic conditioning (RIC) may
reduce ischemia-reperfusion injury in solid organ transplantation.
METHODS: A pilot randomized controlled trial of 60 patients undergoing bilateral sequential lung transplantation assessed the utility of RIC in attenuating PGD. Treated recipients underwent 3 cycles of lower limb ischemic conditioning before allograft reperfusion. The primary outcome measure was a comparison of
the partial pressure of arterial oxygen/fraction of inspired oxygen ratio(P/Fratio) between treatment groups.
RESULTS: No adverse effects of tourniquet application were observed. The mean lowest P/F ratio during the first 24 hours after transplantation was 271.3 mm Hg in the treatment arm vs 256.1 mm Hg in the control arm (p=0.46). PGD grade and severity and the rate of acute rejection also showed a tendency to favor the treatment arm. Sub-group analysis demonstrated a significant benefit of treatment in patients with a primary diagnosis of restrictive lung disease, a group at high risk for the development of PGD. RIC was not accompanied by systemic release of high-molecular-weight group box 1. Levels of cytokines, high-molecular-weight group box 1, and endogenous secretory receptor for advanced glycation end products peaked within 2 hours after reperfusion and likely reflected donor organ quality rather than an effect of RIC.
CONCLUSIONS: RIC did not significantly improve P/F ratios or PGD in this randomized controlled trial. However, encouraging results in this small study warrant a large multicenter trial of RIC in lung
transplantation.
AB - BACKGROUND: Primary graft dysfunction (PGD) remains a significant problem after lung transplantation. Data from animal and clinical studies suggest that remote ischemic conditioning (RIC) may
reduce ischemia-reperfusion injury in solid organ transplantation.
METHODS: A pilot randomized controlled trial of 60 patients undergoing bilateral sequential lung transplantation assessed the utility of RIC in attenuating PGD. Treated recipients underwent 3 cycles of lower limb ischemic conditioning before allograft reperfusion. The primary outcome measure was a comparison of
the partial pressure of arterial oxygen/fraction of inspired oxygen ratio(P/Fratio) between treatment groups.
RESULTS: No adverse effects of tourniquet application were observed. The mean lowest P/F ratio during the first 24 hours after transplantation was 271.3 mm Hg in the treatment arm vs 256.1 mm Hg in the control arm (p=0.46). PGD grade and severity and the rate of acute rejection also showed a tendency to favor the treatment arm. Sub-group analysis demonstrated a significant benefit of treatment in patients with a primary diagnosis of restrictive lung disease, a group at high risk for the development of PGD. RIC was not accompanied by systemic release of high-molecular-weight group box 1. Levels of cytokines, high-molecular-weight group box 1, and endogenous secretory receptor for advanced glycation end products peaked within 2 hours after reperfusion and likely reflected donor organ quality rather than an effect of RIC.
CONCLUSIONS: RIC did not significantly improve P/F ratios or PGD in this randomized controlled trial. However, encouraging results in this small study warrant a large multicenter trial of RIC in lung
transplantation.
UR - http://www.sciencedirect.com/science/article/pii/S1053249814011206
U2 - 10.1016/j.healun.2014.04.022
DO - 10.1016/j.healun.2014.04.022
M3 - Article
VL - 33
SP - 1139
EP - 1148
JO - The Journal of Heart and Lung Transplantation
JF - The Journal of Heart and Lung Transplantation
SN - 1053-2498
IS - 11
ER -